RA Flashcards
(39 cards)
What is Rheumatoid Arthritis (RA)?
Chronic, systemic inflammatory disease of the joints and related structures
What is the pathophysiology related to RA?
- Immune-mediated inflammatory process
- Attacks synovium and other vital organs/tissues
- Erosive, symmetric joint involvement (frequently hands and feet)
- Chronic inflammation of synovial lining ( tissue exceeds borders and erodes into bone and cartilage within joint capsule pannus
- End result: joint destruction and deformity
What are key clinical features of RA?
- Morning stiffness that subsides after at least 30 minutes
- Stiff, painful, tender and/or swollen joints (“boggy” and warm to palpate)
- Progressively symmetrical presentation (Polyarticular)
- Hand/Foot deformities (e.g. Swan-neck, Boutonniere, ulnar deviation, ‘hammer’ toe)
- Constitutional S/Sx
What is the primary objective and goal of therapy for RA?
- Objective: To improve/maintain functional status and improve QOL
- TX Goal: To relieve pain, preserve joint function and prevent/control joint destruction and systemic complications
What are non-drug therapy options for RA?
- Rest
- PT/OT
- Assistive devices
- Weight reduction/management
- Splinting/join protection
What are DMARDs?
(disease modifying anti-rheumatic drugs) a group of drugs that have potential to prevent joint damage
What is the MOST common monotherapy for RA?
Methotrexate (MTX); other may also be used
What are the most common Double DMARD therapy?
Any double combination of MTX, SSZ, HCQ, LEF
What is utilized in triple DMARD therapy?
MTX + SSZ + HCQ
What medications are classified as Non-biologic DMARDs? (4)
- Hydroxychloroquine (HCQ)
- Methotrexate (MTX)
- Sulfasalazine (SSZ)
- Leflunomide (LEF)
How does Hydroxychloroquine (HCQ) function?
Antimalarial; slows progression of erosive bone lesions (may induce remission); relatively fast onset (2-6 months; D/C if no response >6 months)
What are therapeutic uses for Hydroxychloroquine (HCQ)?
- Mild RA
- Combination (Double/Triple DMARD therapy)
- Reserved for RA unresponsive to NSAIDs
What should be monitored when utilizing Hydroxychloroquine (HCQ)?
Minimal
- Ophthalmologic exam bi-annually (retinal toxicity)
- Does not cause liver/kidney/ bone toxicities
What are ADRs associated with Hydroxychloroquine (HCQ)?
- GI: N/V/D (take with food)
- Derm: pruritus, rash, alopecia, INC skin pigmentation
- Neuro: HA, insomnia, vertigo
- Ocular Toxicity
How does Methotrexate (MTX) function?
Acts as immunosuppressive and anti-inflammatory agent (folic acid antagonist); slows appearance of new erosions
What are therapeutic uses for Methotrexate (MTX)?
- 1st LINE monotherapy DMARD
-
MAINSTAY moderate to severe RA (patients not responding to NSAIDs adequately)
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What are ADRs for Methotrexate (MTX)?
- GI: N/V/D, stomatitis (dose-related)
- Hematologic: thrombocytopenia, leukopenia
- Pulmonary: fibrosis, pneumonitis
- Hepatic: ELEVATED liver enzymes, cirrhosis
What is a drug interaction with Methotrexate (MTX)?
- NSAIDs (may DEC Clearance, INC ADRs)
What should be monitored when utilizing Methotrexate (MTX)?
- Baseline: LFTs, CBC, Total bilirubin, HBV and HCV studies, serum Creatinine, albumin
- Q1-2 months: CBC, AST, albumin
How does Sulfasalazine (SSZ) function?
PRODRUG cleaved in the colon to sulfapyridine (anti-rheumatic properties)
What are the therapeutic uses for Sulfasalazine (SSZ)?
- Mild RA
- Combination (Double/Triple)
What should be monitored when utilizing Sulfasalazine (SSZ)?
- Baseline: CBC
- Month 1: CBC Q week
- Continuing: CBC Q 1-2 months
How does Leflunomide (LEF) function?
- Interferes with RNA/DNA synthesis in lymphocytes (reversible inhibitor of DHODH)
- Reduces pain and inflammation associated with RA (slows progression of structural damage)
What are ADRs associated with Leflunomide (LEF)?
- N/V
- HA
- Rash
- Alopecia
- Liver toxicity (CAUTION with Liver disease)
- Pregnancy Category X (Wash cholestyramine out prior to conception)
